Healthcare Provider Details

I. General information

NPI: 1720337827
Provider Name (Legal Business Name): ANDREW MONTEMAYOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 NORTH FINANCIAL DRIVE SUITE 135
FRESNO CA
93720
US

IV. Provider business mailing address

7170 NORTH FINANCIAL DRIVE SUITE 135
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax:
Mailing address:
  • Phone: 559-221-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: